As city drug overdoses dip, providers see more room for improvement

The city Health Department said drug-overdose deaths fell 2.6% last year, to 1,444—the first decrease after seven consecutive years in which the total climbed higher.

Opioids were involved in 80% of those deaths, and fentanyl was the most common substance identified in overdoses, with the drug present in about 6 in 10 cases.

But the number of overdoses continued to climb in some areas of the city. The Bronx, Manhattan and Staten Island all had higher rates of overdose deaths in 2018 than in the previous year. The overdose rate fell 21%, to 273 deaths, in Brooklyn and 20.4%, to 215 deaths, in Queens.

Dr. Lawrence Brown, CEO of Start Treatment and Recovery Centers in Brooklyn, said it's not just deaths that the city should work on addressing but also access to care and retaining people in treatment.

"I'm glad it's going in the right direction," Brown said. "It's not quite to the point that as a clinician I really feel it. But still, even one fewer death is really an accomplishment."

The Bronx continued to have the highest overdose rate, 34.1 per 100,000 people, and the overdose rate increased 8.6% last year, with 391 Bronx residents dying in drug fatalities.

The neighborhoods hit hardest last year were East Harlem, which had an overdose death rate of 56.1 per 100,000 people; the Bronx's Crotona-Tremont, Hunts Point-Mott Haven and Fordham-Bronx Park; and South Beach-Tottenville on Staten Island.

Overdose deaths among Staten Island residents increased 17.5%, to 31.5 per 100,000 people, last year, the second-highest among the five boroughs.

"The decrease in drug-overdose deaths is promising, but far too many New Yorkers are still dying," Health Commissioner Dr. Oxiris Barbot said in a statement. "We are closely monitoring the trends of the epidemic as they evolve and responding to upticks in emergency department visits and deaths with targeted strategies and community engagement."

The city Health Department noted that it has invested $60 million since March 2017 through HealingNYC to prevent overdoses. It has distributed 230,000 kits of naloxone, the drug used to reverse opioid overdoses.

Its Relay program, which deploys peer advocates to emergency departments, is in use at 12 hospitals, with three more slated to join next year.

Preliminary data for the first quarter of this year showed two fewer overdose deaths than during the same span last year.

Mary Callahan, director of outpatient services for Odyssey House, said it has had success reaching people through its state-funded recovery center in the Morris Heights section of the Bronx. There, it has a peer specialist who has experienced addiction and is able to go to bodegas, schools and community events to share that services are available. She said collaboration between treatment providers and the federally qualified health centers that serve Medicaid and uninsured patients could yield results.

"We now have the resources to go into the community rather than just setting up in the community and having folks come to us," Callahan said. "Over time we hope to see some of the fruits of the labor." —Jonathan LaMantia

After strategy shift, MJHS Home Care plans more cuts

The home care business—part of the nonprofit MJHS Health System—has given notice to 28 additional employees after more than 100 were affected earlier this year.

About six months ago, significant changes were made to the business to try to address losses and stabilize it, a spokeswoman for MJHS Home Care said in an email. The new strategy focused on providing home-based services to members and patients already under the care of MJHS Health System.

"Unfortunately, in the process of caring for our existing patients and members, we continued to care for a large number of managed-care cases without having sufficient Medicare episodes to offset them," she said. "This magnified the negative impact of low managed-care reimbursement levels. As a result, the financial picture did not improve as anticipated."

She added that MJHS Home Care hopes to find positions for the affected employees within MJHS hospice as well as its health plans. If that is not possible, it plans to assist with staff placement at other certified home health agencies.

In February Timothy Higgins, chief operating officer of MJHS Provider Services, said, "Inadequate payments from managed-care companies, along with a decline in reimbursement from governmental payers, have led to growing operating losses for MJHS Home Care and other home care agencies throughout New York."

A recent analysis from the Home Care Association of New York State found that agencies reported it takes 58 days on average to collect money from payers.

MJHS Health System also provides hospice and palliative care. It has two centers for rehabilitation and nursing care (the Menorah and Isabella centers) and a research institute for palliative care. Additionally, the health system offers health plans for Medicare and dual-eligible individuals under its Elderplan arm as well as managed long-term care plan HomeFirst. —Jennifer Henderson

CHS doubles operating income in first half

Catholic Health Services of Long Island reported $30.2 million in operating income in the first half of the year, which is nearly double what it earned during that period last year.

Including its $76.9 million in unrealized gains on investments, it earned $106 million, according to unaudited financial statements. Its net income through the first half of 2018 was only $3.3 million.

Through the end of June, total operating revenue increased 5.2%, to nearly $1.45 billion, including a 3.8% increase in net revenue from patient care, which was $1.33 billion. Operating expenses rose 4.1%, to $1.42 billion.

St. Francis Hospital in Roslyn was the system's top earner, bringing in $51.2 million in operating income through the end of June. Good Samaritan Hospital earned $11.5 million. Mercy Medical Center, St. Charles Hospital, St. Catherine of Siena Medical Center and St. Joseph Hospital each lost money.

The health system reported $13.3 million in revenue from DSRIP in the first half of the year, which was 6.8% lower than during the same period last year.

Inpatient admissions at the system increased 3.6%, to about 39,000, in the first six months, and outpatient visits increased 3.2%, to about 318,000. St. Joseph Hospital's operating data is not included in the system's utilization statistics. —J.L.

SUNY Downstate adds program to address nursing shortage

The College of Nursing at SUNY Downstate Health Sciences University is adding a doctor of nursing practice degree program in light of the growing shortage of primary care providers in New York and across the country.

It expects to enroll the first cohort of 10 students in the spring.

The three-year program is open to nurses who already have completed a bachelor of science degree in nursing, SUNY said. Additionally, nurses who have completed a master's of science in nursing may be able to complete the degree in two years.

The program will combine distance and online instruction; a classroom option is available as well.

"The doctor of nursing practice degree program addresses a critical part of the SUNY Downstate mission by preparing nurses to be leaders in improving care and working to eliminate health disparities in ethnically diverse neighborhoods," said Dr. Wayne Riley, president of SUNY Downstate Health Sciences University, in a statement. "With fewer physicians entering primary care coupled with an aging population with more complex health needs, the impact that graduates of our doctor of nursing practice program will have on quality and access to care cannot be overstated."

The program is expected to contribute to training future nurses as faculty for the college and other institutions. SUNY pointed to a recent estimate from the American Association of Colleges of Nursing that there were nearly 1,600 faculty vacancies throughout U.S. nursing schools last year.

The program joins eight other degree and certificate programs, including an accelerated bachelor of science in nursing and a trio of master of science programs.

More than 350 students are enrolled at the college for the 2019-20 academic year, SUNY said. —J.H.

AT A GLANCE

GNYHA LOBBYING: David Rich, executive vice president at the Greater New York Hospital Association, has given more than $900,000 in political donations since 2014, The New York Times reported. The Times questioned whether Rich's donations, which aligned with the hospital association's interests, represented improper contributions on behalf of his employer. Rich denied that. "My personal contributions are mine alone and reflect my passion for, and participation in, the political process,” Rich told the Times.

OPIOID VERDICT: An Oklahoma judge on Monday ruled against Johnson & Johnson in a landmark case, ordering the company to pay $572 million for its role in the opioid crisis that has "ravaged" the state, CNN reported. City Comptroller Scott Stringer, fiduciary for the city's public pension funds, said his office would use its power to influence the company's next steps. "Johnson & Johnson executives made fortunes while fueling our opioid crisis," he said in a statement. "Their bank accounts swelled as the company’s products caused Americans to suffer—and as investors, we’re demanding that the Johnson & Johnson board enforce its clawback policy to hold any executive responsible for misconduct financially accountable."

DETENTION OF CHILDREN: New York Attorney General Letitia James on Monday filed a lawsuit in partnership with 19 Attorneys General against the Trump administration and its rule that permits the prolonged detention of children in immigration custody. The coalition argues that the rule interferes with the ability of states to help ensure the health, safety and welfare of children and that it could lead to long-term negative health consequences.

ORDER ERRORS: Multiple-birth infants had a much higher risk of wrong-patient order errors compared with singletons in neonatal intensive care units, according to a new study by researchers at Columbia University Vagelos College of Physicians and Surgeons, New York-Presbyterian Hospital, Albert Einstein College of Medicine, and other institutions. Columbia announced the study and its publication in JAMA Pediatrics on Monday.

CORRECTION: Memorial Sloan Kettering's David H. Koch Center for Cancer Care will offer outpatient cancer services. A portion of the building will be shared with Hunter College, housing its School of Nursing, science research labs and physical therapy program. The nature of MSK's programs at the center were misstated in the Aug. 26 Health Pulse article, "Koch left major mark on NYC’s medical centers."

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